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FOR OFFICE USE: <br /> �f_`: ceq 1 APPLICATION FOR SANITATION PERMIT Permit No. .. ......... r.... <br /> ----- ------------------ -------------------------------- (Complete in Duplicate) <br /> --------------- This Permit Expires 1 Year From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the wor herein described. <br /> This application YOCATION_Szz�_ _ <br /> ' compliance with County Ordinan6e--No. 549. <br /> JOB ADDRESS lJ � UyLe,,�_.. ...----- -- -- 'Owner's Name--- <br /> 4016-0 <br /> Address r '^-'('E• ,.�- — ------------------------------- <br /> Contractor's Name- - " ....._.,.,.......... Phone................................... <br /> --- --------- -- ----- ----- - <br /> Installation will serve: Residence �partment House ❑ Commercial 1❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __Z__ Number of bedrooms___ Number of baths /-___ Lot size sa. eU_._ .1_..1A-_�___•--___--. <br /> Water Supply: Public system P-1"community system ❑ Private ❑ Depth To Water Table loft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe EY"A'ardpan ❑ <br /> Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No R'-- FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> crl Distance from nearest well-----------------Distance from foundation._-____..._._._----.Material-----------------------------------.____-_--___-. <br /> c No, of compartments----------------- _Size__-______-_-___________ ._Liquid de th__......-.----...___._._ Capacity <br /> &is osal� Distance from nearest we1I.R_6?t0.._Distance from foundlaatiioon4_l '�......Distance to nearest lot line.M.-'.,i <br /> � d Number of lines...... ____ _______ ____Length of each lineL� �7�___'.-____-..Width of trench_!�f!__-............_ o <br /> � r Type of filter materials ,�. .__Depth of filter material------ - ___Total length-------- ^.....a...-__________________ f\�i <br /> Seepage Pit: Distance to nearest well._._________________Distance f om fgundation__cZA9_..___.Dista c� to nearest lot <br /> Number of pits_____ _______________Lining material____ l:__.-Size: Diameter__, --�_--Depth___��---------------- <br /> CK, { <br /> "V <br /> Cesspool: Distance from nearest well-----------------Distance fro oundation------___---_-_-.Lining material,,-,--------------------------------- <br /> 1-71 Size: Diameter--------------------------- ----------Depth----------------------------------------------------Liquid Capacity-------------------------------------------------­--gals. t <br /> Privy: Distance from nearest well------------------------------------------------Distance from nearest building_____-____-_---.----.___.____-.______-.._. <br /> ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- <br /> Remodelingand/or repairing (describe)----------- ---- --------------------------•--------------------_--------_---------- ---:• ------------------------------------------------------- <br /> ----------------•-•-----•--•------••--•--------•------------ ------ •--- ----------------- ----------­------------- -- -------------------.__.--------------••--------------- <br /> s <br /> --------------------------------------------------------------------------- ---- ----- - -- �iilul & <br /> I hereby certify that I have prepar is appl- a lion and that the work done in accordance with San Joaquin County <br /> ordinances, St I , and rules and regulations of the San Joaquin Local Health Distr' t. <br /> [Signed}_ <br /> _..-I ------�. _------�__ - 9 -------- T� j ':•lGr-- Contractor) <br /> By:.- ---------------------- - - - ----------(Title)---------------------------------------..._... --.------ ------ <br /> (Plot plan, showing size of lot, location of system in relation wells, buildings, c-, can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED 4_7 BY------ Y'1�---- -- -----------------------------------•---- DATE------ 4 s <br /> REVIEWEDBY---------------------------------------- ------ -------------------------------------------------------•--• DATE--------------------------------------- <br /> BUILDING PERMIT ISSUED------------------------------- ---------------------------------------------------------------- DATE------------------------------------------ --- <br /> Alteration and/ recom dptio •-•- /� y� �-Q. :r:' --t%:' ;� lI ► <br /> ---•---------------------------------- --------------•---------------- ---------------------------------------------_....---•------------•-----------•-------............--•-•-.......------..._......---._._.I-------------- <br /> ---------_------------------------- <br /> ---- a - -- ; <br /> � � _— ------------ <br /> FINAL. INSPECTION BY------------------------ ------•------------ ------------------. Date-------------------- •-------• ---------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Strout 124 Sycamore Street 205 West 91h Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED 8-59 2M 5-62 ATLAS <br />